DESCRIPTION: Optimal care during chronic renal insufficiency involves the early diagnosis of chronic renal failure (CRF) and the use of interventions to delay its progression. Recent evidence suggests that the quality of care during CRI in the US is sub-optimal. The proposed research project will evaluate certain factors potentially associated with sub-optimal care and their impact on clinical outcomes and cost. The specific aims of this project are: 1) Determine the prevalence and predictors of anemia and hypoalbuminemia among pediatric patients at initiation of dialysis; 2) Determine the clinical outcomes and cost associated with anemia and hypoalbuminemia during dialysis; 3) Determine factors associated with preemptive transplantation and compare outcomes between preemptive transplant and dialysis patients; 4) Determine costs and hospitalizations associated with care of patients with CRF; and 5) Determine costs, and factors associated with cost, during the first year of dialysis with particular attention to the impact of care during CRF. Cross-sectional and retrospective studies will be performed. The data to evaluate referral pattern and outcomes will be obtained from the United States Renal Data System (USRDS), which are already available to the PI. Data to evaluate the effect of poor functional status and the patterns of care among CRF patients will be collected from patients at New England Medical Center, a tertiary care center in the Northeastern region of the US. The results of this study are expected to influence policies and provide insights for strategies to improve the outcomes of patients with chronic renal failure.